摘要目的 分析特发性黄斑裂孔(idiopathic macular hole,IMH)早期术后视力恢复的相关因素.方法 回顾性病例对照研究.对天津眼科医院在2009年1月至2010年12月就诊54例54只眼行玻璃体切割联合内界膜(inter limiting membrane,ILM)剥离术的IMH患者.术后3月最佳矫正视力(Best corrected visual acuity,BCVA)提高并大于0.3 LogMar为A组,BCVA不提高或提高但小于等于0.3 LogMar为B组.Logistic回归分析裂孔OCT (optical coherence tomography)参数、裂孔分期、ICG染色剥离ILM等对视力的影响.结果34只眼行ICG染色；54只眼术后裂孔均达到解剖闭合；视力提高组35只眼,占64.8％；视力不提高组19只眼,占35.2％.裂孔最小直径(minimum diameter,MD)、裂孔牵拉指数(tractional hole index,THI)、术后IS/OS连续性中断最大直径(maximum diameter ofdisruption of inner/outer segments of photoreceptors,IS/OS D2)、脱离感光细胞活性级别(the gradingof viability of detached photoreceptors,V)、ICG染色及裂孔分期差异有统计学意义(t=3.96、-5.04、6.10,P=0.000、0.000、0.000; x2=16.89、12.38,P=0.000、0.000).Logistic回复分析示裂孔牵拉指数、术后IS/OS连续性中断最大直径、脱离感光细胞层活性级别、未行ICG染色为IMH早期术后视力的独立危险因素(OR=114.78、26.88、24.19、81.75;P=0.046、0.011、0.030、0.034).结论 上述因素可为临床工作中评估IMH术后视力恢复提供一定参考依据.

abstractsObjective To investigate the risk factors that effect postoperative visual acuity improvement of idiopathic macular hole in early stage. Methods Retrospective observational case series.Fifty-four eyes of 54 subjects who had undergone pars plana vitrectomy with inner limiting membrane (ILM) peeling for the treatment of idiopathic macular hole were included.The main outcome measures included pre- and postoperative 3 months clinical examination and SD OCT findings:the factors of the macular hole and the maximum diameters of the disruption of the junction between inner/outer segments of the photoreceptors.Subjects were divided into 2 groups according to the improvement in log MAR visual acuity:group A had improved visual acuity ≥0.31ogMAR;Group B had improved less then 0.31ogMAR or had worsening of BCVA. Results Thirty-four eyes had ILM peeling with ICG staining; all eyes had MH anatomically closed; group A had 35 eyes (64.8％) where as group B had 19 eyes (35.2％).Minimal diameter,tractional hole index,postoperative maximum diameter of disruption of inner/outer segments,the grading of viability of detached photoreceptors,ICG staining were statistically significant (t =3.96,-5.04,6.10,P =0.000,0.000,0.000; 2=16.89,12.38,P =0.000,0.000,respectively).Logistic regression analysis identified that tractional index,postoperative maximum diameter of disruption of inner/outer segments,the grading of viability of detached photoreceptors,without ICG staining were risk factors in visual acuity improvement (OR=114.78,26.88,24.19,81.75;P =0.046,0.011,0.030,0.034,respectively). Conclusions Above results can provide a simple model to evaluate visual recovery of idiopathic macular hole after surgery.